Impact on our Mental Health. Biological Changes Psychological Changes Social Changes Professional Services Coping Skills

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2 Impact on our Mental Health Biological Changes Psychological Changes Social Changes Professional Services Coping Skills

3 Biological Changes After a brain injury, biological impacts may affect mental health in the following ways: Neuro-Chemical Changes (Cellular level) Injury to Brain Systems Hormonal Changes

4 Neurochemical Changes Neurons are brain cells which communicate with each other via a electro chemical process Neurons receive and transmit information through both electrical impulses and chemical messengers (neurotransmitters)

5 Brain Neurons

6 Brain Neurons Shearing : Neuron Damage due to Brain Injury

7 Neurotransmitters regulate Feelings of Happiness Drive and Motivation Ability to Focus Emotional Stability Mental Alertness Good Feelings Toward Others Calmness in the Face of Difficulty 3 most common that regulate our mood are Serotonin, Dopamine and Norephinephrine Damage can affect the neuron s ability to fire electrical signals, impacting the release of neurotransmitters

8 Injury to Brain Systems Contusion Increased Intracranial Pressure Hemorrhagic or Ischemic Stroke McCormick, (2011)

9 Frontal Lobe Injuries Some functions of the Frontal lobe that impact our mental health include: Initiation Judgment Inhibition of behavior Self-Monitoring Personality/Emotions Awareness of abilities/limits Mental Flexibility

10 Temporal Lobe Injuries Some functions of the Temporal lobe that affect our mental health include Emotional Regulation Amygdala Memory Hippocampus

11 Hormonal Changes Damage to hypothalamus and pituitary gland which regulate hormone secretion Hormone disturbances can contribute to: Depression, Sexual Difficulties, Mood Swings, Fatigue, Headaches Cortisol- the stress hormone May be secreted during body s fight or flight response to stress-ptsd State of chronic stress or activation

12 Psychological Changes Depression Post Traumatic Stress Disorder (PTSD) Substance Abuse Suicidality Grief and Loss

13 Depression 42% of persons with brain injury develop depression 53.1% met criteria for Major Depressive Disorder (MDD) during the first year post injury 23.3% experienced MDD for the first time ever after injury Less than ½ of survivors with depression seek treatment Karol (2011)

14 Depression Symptoms Depressed almost every day Lack of pleasure and interest Loss of motivation to do things Changes to sleep Changes to appetite Repeated thoughts of death Suicidal thoughts and/or attempts ** If symptoms persist for several weeks, seek professional treatment

15 Post Traumatic Stress Disorder PTSD is an anxiety disorder where an individual has been exposed to a traumatic event Can be co-occuring with TBI (especially in military populations) PTSD and MTBI look similar

16 PTSD Symptoms Re-experiencing (images, flashbacks) Avoidance (withdrawn, numbing, detached from others) Hyper arousal (irritability, outbursts, hyper vigilance, impaired concentration, startled easily) McCormick, 2011

17 Substance Abuse 50-66% of patients hospitalized for TBI have a history of substance abuse Most co-occuring mental health issue after TBI 48% Substance dependence Self-medicate to cope Brain Injury makes impulse control more difficult McCormack, 2011

18 Substance Abuse Treatment Treatment includes cognitive behavioral therapy, motivational interviewing, medication, self-help communities (AA) Substance Abuse and Mental Health disorder s must be treated simultaneously

19 Suicide Survivors of brain injury have an increased risk of suicide TBI survivors have an 8% lifetime rate of suicide attempts compared with 2% of the general population. People with severe TBI are 4 to 8 times more likely to commit suicide compared to the general population Individuals with a history of psychiatric diagnoses, emotional disturbance and substance abuse problems were 21 times more likely to make a post-injury suicide attempt compared to those without. McCormack, 2011

20 Suicide Risk Increase Risk Previous attempts Suicidal thoughts Substance abuse Co-Occuring mental illness Feeling hopelessness Decrease Risk Sense of responsibility to others Spirituality Social support Problem-solving skills Reality testing SAIL, 2008

21 Suicide-Things that can help Psychotherapy Support groups Medication Safety planning Having a belief system Support system Suicide hotline: TALK

22 Natural and normal response to loss Ambiguous Loss: occurs when a person is physically present but psychologically absent Grief and Loss

23 Grief and Loss We evaluate our self-concept Can have negative emotions May feel lower confidence and self-worth Others grieve Re-grieve throughout our life Ways to cope

24 Social Systems Faith Family Leisure Friends Community Work

25 Society's view of disability-cultural Context Work/Hobbies (Social and Economic Context) Friends/Family (immediate environment) Person with a Brain Injury

26 Sabela (2011) Changes in Family Structure Changes in family economics Changes in work Changes in Family Roles Changes in family Member Relationships

27 Wood & Yrdakul (1997) Changing Family Dynamics High Stress-may actually over time Marital Strain Intimacy, Communication, Role adjustment = High rates of divorce Anxiety Depression Feelings of Grief and Loss Social Isolation Social supports for family and person with brain injury

28 Changing Abilities Change in one s ability to work or enjoy hobbies may impact: Confidence Self-Efficacy Experiencing of grief or loss Identity Acceptance of Self

29 Our Society and Brain Injury Understanding may be limited Barriers to care Medical Model Silent epidemic

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31 Seeing a Mental Health Therapist is a recognition of how emotionally challenging it can be to have a brain injury. It does not imply that you are weak or mentally ill rather, grief is normal but people tend to handle significant life changes better when they can discuss them with others. (Niemeier & Karol, 2011)

32 Professional Services Therapy Individual Therapy Group Therapy Assessment Psychiatric Services Medication Management Alternative Therapies Biofeedback, Acupuncture, Yoga Social Worker Case Management, Advocate

33 General Coping Skills Attend a support group Become involved in something Take care of your body Practice relaxation techniques Take time for self care & recreation Practice positive self-talk List your goals and accomplishments

34 Suggestions for Coping Anxiety: relaxation exercises, meditation, deep breathing Intrusive thoughts: distract yourself with pleasurable activities; blink your eyes over and over; thought stopping techniques Sleep issues: avoid caffeine in the evening, don t nap, medications, relaxation CD s Neimeier & Karol, 2011

35 Suggestions for Coping Worrying: schedule worry time in the day and only allow yourself that time to worry; distract with favorite activities Fear: write your goals and talk them out, focus on accomplishments, go to a safe place, hold onto a familiar/safe object Angry outburst: avoid doing too much at one time, rest, tell yourself stop and think Neimeier & Karol, 2011

36 Parents Coping for Others Pace yourself (it s a marathon not a sprint) Seek professional advise Emotional support from your family/friends Self-care Try to maintain your involvement with work and/or interests Neimeier & Karol, 2011

37 Spouse/Partners Coping for Others Ask help from friends and family Be aware of your own needs make a checklist Share you feelings Couples Counseling Adult Children Seek emotional support Take time to contemplate role changes Niemeier & Carol, 2011

38 Questions?

39 References Landau, J., & Hissett, J. (2008). Mild traumatic brain injury: impact on identity and ambiguous loss in the family. Family Systems & Health, 26(1), Karol, R. (2011). Appreciating Grief and Loss After Brain Injury [PowerPoint slides]. McCormack, M. (2011). Outpatient Therapy for Mental Health Diagnoses With Survivors of Mild Traumatic Brain Injury [PowerPoint slides]. Niemeier, J. & Karol, R. (2011). Overcoming Grief and Loss after Brain Injury. New York: Oxford. Sabella, S. (2011). Family Matters after Brain Injury [PowerPoint slides]. Self Advocacy for Independent Life: An Advocacy Workbook for People with Brain Injuries and their Families. (2008)